Provider Demographics
NPI:1457093585
Name:DIAZ, CARMEN E (LPC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:E
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4081 DE ZAVALA RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2082
Mailing Address - Country:US
Mailing Address - Phone:210-971-4380
Mailing Address - Fax:
Practice Address - Street 1:4081 DE ZAVALA RD STE 201
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78249-2082
Practice Address - Country:US
Practice Address - Phone:210-414-5398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-09
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor